Zika Linked Fetal Brain Disruption Syndrome Throughout Pregnancy - Lancet

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Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30902-3/fulltext

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Summary

Background

In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival.

Methods

We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams.

Findings

Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores −1·54 vs −3·13, difference 1·58 [95% CI 1·45–1·72]); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0·28 [95% CI 0·14–0·56]); and were less likely to have a history of rash during pregnancy (20·7% vs 61·4%, ratio 0·34 [95% CI 0·27–0·42]). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above −2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015.

Interpretation

Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies.

Funding

Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.

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HEALTH

 

ZIKA VIRUS OUTBREAK

 

JUN 30 2016, 12:15 PM ET

New Zika Studies Reveal Invisible Damage to Babies

by MAGGIE FOX

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Zika virus causes different types of brain damage in babies, not just microcephaly, according to two new reports.

Brazilian researchers found as many as one in five babies born with brain damage caused by Zika had normal-sized heads. That means babies who may seem normal may in fact suffer from serious conditions that parents and doctors may not notice until they get older.

 

Pediatrician Alexia Harrist from the United States' Centers for Disease Control and Prevention (CDC) examines 3-month-old Shayde Henrique, who was born with microcephaly, in Joao Pessoa, Brazil, Tuesday, Feb. 23, 2016. Andre Penner / AP

The findings show that if a pregnant woman is infected with Zika — even if a baby is born with a normal-sized head — the child could have severe brain damage.

"ABOUT ONE IN FIVE DEFINITE OR PROBABLE CASES HAD HEAD CIRCUMFERENCES IN THE NORMAL RANGE."

Worse, the study confirms that many of the pregnant women whose babies were affected didn't have the obvious symptoms of Zika, such as a rash. The virus is known to cause invisible infections in most people who catch it — usually good news, but that's bad news for pregnant women who may not know anything is amiss until their babies start showing symptoms as they grow.

And the study also found that even late in pregnancy, babies can suffer brain damage caused by Zika. In other words, there's no stage of pregnancy that's safe.

Dr. Cesar Victora of the Federal University of Pelotas in Rio Grande do Sul, Brazil, looked at 602 newborn babies suspected of having been affected by Zika.

"About one in five definite or probable cases had head circumferences in the normal range," they wrote in their report, published in the Lancet medical journal.

Related: Can I Ever Get Pregnant If I've Had Zika?

That suggests that many babies may have been part of Brazil's Zika epidemic but their doctors and parents may not yet know. "The finding of several newborn babies with neuroimaging abnormalities despite normal sized heads suggests that the initial focus on microcephaly was too narrow," they wrote.

Other studies have shown that Zika homes in on developing brain and nerve cells and doctors feared babies who seemed fine at first in fact would have brain damage caused by Zika. This study confirms it's true.

 

Geovane Silva holds his son Gustavo Henrique, who has microcephaly, at the Oswaldo Cruz Hospital in Recife, Brazil, on Jan. 26. UESLEI MARCELINO / Reuters

Other studies have also shown that Zika causes far more symptoms than microcephaly alone. Babies born to moms infected with Zika can have vision and hearing problems and other disorders that depend on just what part of the brain the virus has damaged.

Zika targets brain and nerve cells. The Brazilian team's finding confirms this happens throughout pregnancy.

"As expected, the earlier the rash occurred during pregnancy, the smaller was the mean head circumference at birth, suggesting a causal association," they wrote.

"Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal-sized heads," they added.

Related: Zika Study Will Track 10,000 Pregnant Women

"Among Zika virus affected pregnancies, some fetuses will have brain abnormalities and microcephaly, others will have abnormalities with normal head sizes, and presumably others will not be affected."

"RASHES IN THE THIRD TRIMESTER OF PREGNANCY WERE ASSOCIATED WITH BRAIN ABNORMALITIES DESPITE NORMAL-SIZED HEADS."

Another recent study found that while Zika usually clears up within two weeks at the longest, pregnant female monkeys could be infected for as long as two months. Doctors suspect the same thing may happen in pregnant women and if that's the case, the virus could affect a developing baby all during the time, as well.

And, Victora's team said, newborn babies may be at risk, also.

In another report in Lancet, Dr. Sherif Zaki of the Centers for Disease Control and Prevention and colleagues examined three Zika-affected babies who died after they were born, and the placenta from two babies who miscarried.

They found Zika caused many different types of brain damage as well as limb and genital malformations. The two women who miscarried were infected early in pregnancy, and lost the pregnancies soon after, they said

http://www.nbcnews.com/storyline/zika-virus-outbreak/new-zika-studies-reveal-invisible-damage-babies-n601736